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Reducing transmission in the food chain

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Presented by Delia Grace at a short course on "Antimicrobial resistance: A multidisciplinary approach", London, UK, 18 July 2019.

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Reducing transmission in the food chain

  1. 1. Reducing transmission in the food chain Delia Grace International Livestock Research Institute, Kenya Short course on Antimicrobial resistance: A multidisciplinary approach London School of Hygiene and Tropical Medicine 18 July 2019 Monday 15th – Friday 19th July 2019
  2. 2. Learning objectives 1. Get an overview of global livestock and fish value chains 2. Understand use of AM in global livestock/fish production and its trends 3. Understand the drivers of AM use in the food chain 4. Identify a business case for reduction of AM transmission in food chains 5. Review some successes in reducing AM transmission
  3. 3. CIMMYT Mexico City Mexico IFPRI Wash. DC USA CIP Lima Peru CIAT Cali Colombia Bioversity International Rome Italy AfricaRice Cotonou Benin IITA Ibadan Nigeria ILRI Nairobi Kenya Addis Ababa, Ethiopia World Agroforestry Nairobi Kenya ICARDA Beirut Lebanon ICRISAT Patancheru India IWMI Colombo Sri Lanka IRRI Los Banos Phillippines WorldFish Penang Malaysia CIFOR Bogor Indonesia CGIAR Research Centres
  4. 4. 4 Human health Societies, cultures, Economies, institutions, Policies Agroecosystem health Animal Health Vet Pub Health EcoHealth One medicine ONE HEALTH Wildlife health Plant health AMR is a One Health issue
  5. 5. What the world eats – grams per day 0 500 1000 1500 2000 2500 Africa Southern Asia South east Asia China Europe Food types (gram per capita per day) Livestock Fish Cereals Pulses Tree nuts Vegetables Fruits Oils Starch roots Sugars Europeans eats five times as much LP as Africans
  6. 6. What the world eats: protein 0 20 40 60 80 100 1961 1971 1981 1991 2001 2011 1961 1971 1981 1991 2001 2011 1961 1971 1981 1991 2001 2011 1961 1971 1981 1991 2001 2011 1961 1971 1981 1991 2001 2011 Dailypercapitaproteinsupply (g/cap/day) Animal Fish Vegetal World Europe South-Eastern Asia Southern Asia sub-Saharan Africa Courtesy Mats Lannerstad. Grace et al. (upcoming) Daily per capita protein supply Annual per capita protein supply 0 10 20 30 40 50 60 70 80 90 100 1970 1980 1990 2006 2030 2050 Annualpercapitasupply (Kg/person/yr) World pulses, dry meat milk and dairy (exc. Butter) 1970 1980 1990 2006 2030 2050 Sub-sarahan Africa 1970 1980 1990 2006 2030 2050 South Asia
  7. 7. Where the food comes from Source: Options for the Livestock Sector in Developing and Emerging Economies to 2030 and Beyond. World Economic Forum White Paper January 2019
  8. 8. Future trends in livestock/fish productionProduction(millionsoftonnes) LMICs Year HICs
  9. 9. Reducing……… transmission in the food chain a) antimicrobial residues b) antimicrobial resistant pathogens c) antimicrobial resistant microbes
  10. 10. Causes of foodborne disease 0 5,000,000 10,000,000 15,000,000 20,000,000 25,000,000 Microbes Helminths Aflatoxins Other toxins Burden in developing countries in DALYs per year zoonoses non zoonoses Havelaar et al., 2015
  11. 11. Reducing AMR transmission transmission in the food chain from food systems
  12. 12. Antimicrobial use in livestock • Total consumption in the livestock sector in 2010 estimated at 63,151 tons • Global antimicrobial consumption will rise by 67% by 2030 • It will nearly double in BRICS nations • More than 73% of all antimicrobials sold in the world are used in animals
  13. 13. Where AM are used in food chains Source: Van Boeckel et al. (2015) Global antimicrobial consumption in livestock (mg per 10km pixel)
  14. 14. 14 Antibiotic use: Vietnam Livestock farmers • 45 antibiotics from 10 classes • 100% industrial farmers treat themselves; 60% of household farmers Cuong et al al., 2015
  15. 15. Can we regulate our way to reduce transmission? • Salbutamol – ‘growth promoter’ in pigs • Clearly illegal in Vietnam • High concern of authorities and consumers • Easy to test for In 2015, 6,000 kg salbutamol imported and sold: 10 kg had a legitimate medical use (Van Duan & Huong 2016) 11% of packaged feed and 4% of pork pooled samples were positive for chloramphenicol, a banned substance; (Tuyet-Hanh et al, 2017)
  16. 16. 16 Africa: dozens of vets, tens of millions livestock
  17. 17. AM usage – 80% non professionals
  18. 18. 18
  19. 19. Systems run by professionals
  20. 20. Can we educate our way to reduce transmission?
  21. 21. • Animal disease is a key constraint: Billions die each year from preventable & curable disease • As livestock systems intensify in developing countries, diseases may increase Young Adult Cattle 22% 6% Shoat 28% 11% Poultry 70% 30% Otte & Chilonda, IAEA Annual mortality of African livestock ( Around half due to preventable or curable disease ) Are there downsides if we reduce use in livestock and fish?
  22. 22. Emerging zoonotic disease events, 1940−2012 Grace et al., 2012
  23. 23. • How much human AMR comes from agriculture? • What interventions could reduce use in agriculture? • What are the costs and benefits of these interventions? What are the un-intended consequences? Are interventions feasible? • What effect does the intervention have on human AMR? • What effect does the intervention have on human and animal well-being? What should we do about AM in food chains?
  24. 24. What we know HIC LMIC How much AMR from agriculture? Certainly a little, maybe more Don’t know Interventions shown to reduce AMU at scale Yes No Interventions are affordable Yes Don’t know Interventions are feasible Yes Maybe not Un-intended negative consequences Likely small May be large Interventions appreciably reduce AMR in people Don’t know Don’t know Effect on human and animal overall well-being Don’t know Don’t know
  25. 25. Evidence gaps on Ag AMU 21 acceptable studies No RCTs, most farm workers, most non-pathogen 24% reduction in AMR in people
  26. 26. Reducing transmission in food chains • Customer pressure, societal will • Legislation, regulation, enforcement • More rational use of antimicrobials • Alternatives to antimicrobials – Phages, pro-biotics, heavy metals • Obviating need for antimicrobials – Vaccines, management, genetics
  27. 27. A successful intervention
  28. 28. UNAIDS, 2017
  29. 29. 29
  30. 30. 30 Randomized Lost to follow up at two weeks Villages=0 Farmers=11 Sick cattle= 51 Allocated to control Villages =23 Farmers =226 Sick cattle identified by farmers=475 Lost to follow up at two weeks Villages=0 Farmers=20 Sick cattle =51 Allocated to intervention Villages =23 Farmers =218 Sick cattle identified by farmers=450 Data analysis Control Villages=23 Farmers=208 full, 16 some, 2 none Sick cattle = 401 full, 23 some, 51 none Data analysis Test Villages=23 Farmers=197 full, 18 some, 3 no Sick cattle=377 full, 22 partial, 51 none Allocation Follow-up Analysis Followed CONSORT
  31. 31. 31 Results • 1. Greater knowledge increase 30 points vs 8 Diagnostic signs 84% intervention vs. 57% control) • 2. Better practice 16 ml vs. 12 ml • 3. Better clinical outcomes Failure 1% vs 2%; SA 15% vs. 25% • 4. Benefits both short and mid term. • 5. No overall increase in drug use
  32. 32. A hopeful intervention Launched during partner event, 21/22 February in Nairobi Antimicrobial Resistance Hub www.amr.cgiar.org
  33. 33. AMR in the CGIAR: Activity focus Partnerships AM use and value chains Transmission dynamics Interventions Enabling policy Capacity
  34. 34. For more information: www.amr.cgiar.org
  35. 35. Conclusions 1 AM usage in animals: • likely to lead to resistance in animal pathogens • Likely to lead to increase circulation of resistant strains of zoonotic pathogens (especially foodborne pathogens) • Possibly, but rarely demonstrated, could lead to resistance of human pathogens (not zoonotic). Only demonstrated in few cases. • For human pathogens – it is unlikely the primary source of resistance comes from AM use in animals.
  36. 36. • Animal agriculture uses more AM than human health does and is rapidly trending up • Most use and most growth in use is in LMIC • Dual challenge: access as well as excess • AMR is not the only externality of disease in LMIC and trade-offs need to be examined • Evidence should under-pin a business case but is mostly lacking for LMIC • Yet there is a strong rationale for One Health as the best approach for solving cross-sectoral challenges Conclusions 2
  37. 37. This presentation is licensed for use under the Creative Commons Attribution 4.0 International Licence. better lives through livestock ilri.org

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